Osteomyelitis – Making the Diagnosis

In the patient population at Parkland, osteomyelitis (OM) usually results from direct extension of adjacent soft tissues (i.e. diabetic foot ulcers, or sacral decubitus ulcers), but can also result from hematogenous spread, or direct inoculation as a result of trauma or surgery.  Given the lack of sensitive physical exam findings, and the unavailability of time-consuming imaging modalities in the ED (magnetic resonance and/or bone scintigraphy), OM can be a difficult and sometimes elusive diagnosis to make in the Emergency Department.

Osteomyelitis

53M s/p TMA p/w new ulcer.  Elevated inflammatory markers and clear cortical involvement on XR (although not called by radiology); MR confirmed oseteo.  Findings suggestive of OM on radiography include cortical erosion, periosteal reaction, mixed lucency, and sclerosis; but may not be evident for up to 2 weeks into the infection.